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Average Ratings 0 Ratings

Total
ease
features
design
support

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Write a Review

Description

Claims adjudication services cover a range of areas including medical, dental, vision, and prescription claims, as well as short and long-term disability cases. These services can be accessed either on-site with a license or through a hosted application model (ASP). Utilizing Microsoft technology, the system is powered by an SQLServer database paired with a Windows front end. Our customer service is highly regarded, staffed by healthcare claims professionals who boast a minimum of 12 years of industry experience. All support inquiries are recorded, and their statuses can be monitored online. The system features a plan copy and modification tool that facilitates rapid plan implementation. Auto-adjudication is achieved through benefit codes that are constructed using business rules derived from over 25 variables connected to both the claims and the claimants, which are then processed by the adjudication engine. Claims can be submitted in various formats, including scanned images, EDI, or paper submissions. The system is compliant with HIPAA EDI 5010 transaction sets, ensuring secure and efficient processing. Additionally, re-pricing fees and UCR schedules can be pre-loaded into the system prior to their effective dates, while the date-driven logic ensures that re-pricing occurs based on the service date, optimizing the claims processing workflow. The comprehensive nature of this system allows for a more streamlined and efficient claims management experience.

Description

Streamlined verification processes, combined with specialized knowledge and a high level of automation, significantly minimize voucher transaction costs. At the heart of this system lies Sumex Core, which serves as the foundation for automated electronic invoice validation. This platform encompasses business components and workflows that can be configured and customized in a modular fashion to suit various needs. For effective invoice validation, having up-to-date and accurate tariff and reference data is crucial. Sumex gathers this reference data from publicly accessible resources, processes it promptly, and makes it available via the Sumex tariff server. Furthermore, this information is displayed in an accessible information system, allowing experts to reference it during the billing process. DRG Expert enhances the oversight of billing for acute care services, adhering to SwissDRG guidelines. It not only presents case data in line with regulations but also includes essential statistical indicators and enables what-if scenarios for better decision-making. This comprehensive approach ensures that all stakeholders have the necessary tools to maintain accuracy and efficiency in billing practices.

API Access

Has API No 

API Access

Has API No 

Screenshots View All

Screenshots View All

Integrations

Siddhartha No 

Integrations

Siddhartha Yes 

Pricing Details

No price information available.
Free Trial No 
Free Version No 

Pricing Details

No price information available.
Free Trial No 
Free Version No 

Deployment

Web-Based Yes 
On-Premises No 
iPhone App No 
iPad App No 
Android App No 
Windows No 
Mac No 
Linux No 
Chromebook No 

Deployment

Web-Based Yes 
On-Premises No 
iPhone App No 
iPad App No 
Android App No 
Windows No 
Mac No 
Linux No 
Chromebook No 

Customer Support

Business Hours Yes 
Live Rep (24/7) No 
Online Support Yes 

Customer Support

Business Hours Yes 
Live Rep (24/7) No 
Online Support Yes 

Types of Training

Training Docs No 
Webinars No 
Live Training (Online) No 
In Person No 

Types of Training

Training Docs No 
Webinars No 
Live Training (Online) No 
In Person No 

Vendor Details

Company Name

Complete Health Systems

Website

completehealthsys.com/claims/

Vendor Details

Company Name

Sumex

Founded

2019

Website

www.sumex.ch/en/Sumex-Suite

Product Features

Claims Processing

Adjustor Management No 
Case Management No 
Claim Resolution Tracking No 
Co-Pay & Deductible Tracking No 
Compliance Management No 
Customer Management No 
Electronic Claims No 
Forms Management No 
Paper-Based Claims No 
Payor Management No 
Policy Administration No 

Product Features

Claims Processing

Adjustor Management No 
Case Management No 
Claim Resolution Tracking No 
Co-Pay & Deductible Tracking No 
Compliance Management No 
Customer Management No 
Electronic Claims No 
Forms Management No 
Paper-Based Claims No 
Payor Management No 
Policy Administration No 

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